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Erectile dysfunction (ED) or impotence is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. In all, these studies proved that Tribulus works very well in curing sexual dysfunctions and maximizing sexual performance when taken regularly. Secondary impotence, defined as the loss of erectile function after a period of normal function, is more common. The man's comfort level is also frequently a factor, especially in maintaining an erection. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. Although they are generally safe and free of side effects (unlike chemical drugs), it is important to know that the quality of their extraction and preparation processes varies widely. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. A note of caution: Although there are many Tribulus extracts available over the counter today, almost all of these have been found not to contain any significant amount of the active ingredient. Other studies have suggested that Tribulus also acts by increasing the level of dehydroepiandrosterone (DHEA), a naturally occurring substance in the body believed to be important for a healthy sex drive. The same goes for alcohol and narcotics, like heroin and cocaine. Once an erection is achieved, the man places the elastic ring on the base of his penis, which keeps blood from draining from the penis back into the body. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. No known side effects are linked with this herb. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light. Although they are often dismissed as ineffective solutions to impotence, more and more clinical research studies have found that herbs can help impotent men.